Recently, I was reviewing a new prescription for a patient. It was not the clinical ramifications of the newly prescribed Humolog and Lantus that caught my eye. What caught my attention was the fact that on one of the prescriptions I was making money and on the other I was losing money. At issue is the arbitrary nature of......
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The concept of Pay for Performance as it pertains to healthcare is simple: save the system money by performing and receive a financial reward. Fail to perform and you will reap the financial consequences. Some models even require a financial stake from the provider before they are allowed to participate. An entry fee, as it were. The......
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I just read an interesting post from iMedicare about the Pharmaceutical Steering. Some of this appears to be the steering patients to preferred pharmacies, but the any willing provider concept is not being applied. In one case mentioned in the article, it may actually be anti-competitive. Other cases may be bait-and-switch tactics, with services being initially......
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Recently I received an after-hours call from a rehabilitation facility. One of my patients was recovering from surgery and they were out of one of her medications.  Normally, a call like this would be a routine delivery and the story would end here. Instead, this call transformed in my latest adventure in Tales from the Counter.......
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This week’s tales from the counter deals with the high risk medication Zolpidem. The other day, I received a call from a patient concerned with their copay for zolpidem. The patient’s copay increased to over $90 for a 2 month supply. This was up by 200% compared to the previous refill, and she had concerns about being able......
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Most pharmacists have stories of how the PBMs have overstepped their bounds in the arena of patient care. This blog has documented several examples over the last year, and a recent encounter serves as today’s edition of Tales from the Counter. One of our patients was started on finasteride 5 mg by their urologist. Later......
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The juggernaut that is the PBM industry continues to write the rules and the providers (pharmacies) and the payor (business and the government) pay the price. Eventually someone has to ask the obvious question: why are PBMs so profitable? The answer is lies in what they don’t tell us. At least some business are interested......
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Recently, a petition asking the Executive Branch of our government to look at the business practices of Pharmacy Benefit Managers was started on Whitehouse.gov. It is entitled: CMS NEEDS TO ENSURE TRANSPARENCY IN ITS ROBUST BUSINESS RELATIONSHIP WITH THE LARGE PHARMACY BENEFIT MANAGERS (PBMS) Three large PBMs manage prescription drug benefits for more than 180......
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Have you ever seen an informercial late at night? The announcer is so energetic. They work very hard to make you really want their product. Does this sound familiar? It slices! It dices! You will wonder how you ever got along without it! What would you pay for this time-saving wonder? $99? $59? What if we......
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The Thriving Pharmacist covers a lot of serious pharmacy topics. But sometimes a little good humor is in order. Recently, on Slate, a great pharmacy related quiz appeared: Is it a Pokemon or a Cholesterol Medication. Be sure to check it out. For those Pokemon Go! players out there, be sure to catch only the Pokemon. Some......
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